Healthcare Provider Details

I. General information

NPI: 1215247390
Provider Name (Legal Business Name): NATALIE ANN KNABB O.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4890 BIG ISLAND DR STE 1
JACKSONVILLE FL
32246-7490
US

IV. Provider business mailing address

480 S 1ST ST
MACCLENNY FL
32063-2543
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-5658
  • Fax: 904-564-2646
Mailing address:
  • Phone: 858-705-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4621
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: